Blood clot episode deserves another look

Published 2:51 pm, Friday, February 22, 2013

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DEAR DR. ROACH: Last February, I had a massive DVT from my ankle to mid-thigh. I had no pain at all and walked 3 miles shortly before my regularly scheduled physical. I missed that my leg was very swollen. My doctor stated that that was one of the traditional reasons for getting a DVT.

I have taken Coumadin for the past 10 months. One doctor says I should take this medication for the rest of my life, since the clot was so large and there was no reason for my having gotten one. The other says that since this was the first clot I have ever had, I can stop taking the Coumadin and observe the leg for new swelling/pain. I am otherwise in very good health. I am totally indecisive about what to do. What would you recommend?

— M.D.

DEAR M.D.: A DVT (deep venous thrombosis) is a blood clot in the large veins of the thigh and pelvis. These cause trouble by themselves, by producing leg swelling that can range anywhere from annoying to disabling, but more importantly, they can break off and travel up into the lungs, called a pulmonary embolus. Pulmonary emboli can be life-threatening, since large ones reduce blood supply to the lungs and can even prevent blood from coming out of the heart at all.

Most authorities recommend lifelong warfarin (Coumadin) only after a second episode of DVT in a case like yours, where there is no clear reason for having had one. However, clinical judgment may sometimes cause a physician to advise lifelong warfarin after a single event, especially one that's life-threatening — say, a large pulmonary embolus.

Taking warfarin long term definitely would decrease the risk of a serious blood clot, either in the legs or the lungs, but it also would increase the risk of abnormal bleeding, something that can be serious.

In my opinion, because the initial blood clot was not life-threatening, I would probably agree with your second doctor to not continue the warfarin for the long term. However, your doctors should look carefully for some other reason why you had the blood clot in the first place. Please let me know what they find, and what you decide.

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DEAR DR. ROACH: Has modern medicine come up with any remedy for the loss of equilibrium and balance that we elders encounter? Surgery, perhaps?

— L.M.F.

DEAR L.M.F.: Definitely not surgery. Balance is a complex system involving eyes, a sense of where your limbs are (proprioception) and where gravity is, through the organ of balance in the inner ear. Finding out which system might be making you off-balance can be tricky. Fortunately, balance exercises — ideally supervised by an occupational or physical therapist — almost always help.

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DEAR DR. ROACH: My company checks cholesterol once a year. My level is 256. I know this is in the high range, but what is the difference between fasting against non-fasting? Would the level be higher or lower if I were to do a fasting cholesterol check?

— M.S.

DEAR M.S.: Eating usually has only a small effect on total cholesterol — raising it a little, in most people. What is more important is the result of the HDL cholesterol. A healthy diet with lots of vegetables, fruits and little red meat can help cholesterol level in almost everybody.